Overcoming COVID-19 vaccine hesitancy hurdles
Authors: Chengliang Yang, Linda Lapp, Scott J Tebbutt
Journal: The Lancet (2023)

Vaccine hesitancy and the spreading of misinformation continue to be important barriers to implementing crucial public health interventions to reduce the spread of COVID-19, according to the report by WHO Director-General Tedros Adhanom Ghebreyesus from the 14th meeting of the International Health Regulations COVID-19 Emergency Committee. The systematic review and meta-analysis by the COVID-19 Forecasting Team overemphasises that past SARS-CoV-2 infection provides protection from COVID-19. The review fails to appropriately highlight that it focuses on past variants and does not explain their findings regarding the protection from past SARS-CoV-2 infection against re-infection in the unvaccinated population, especially in the vaccine hesitant group.1COVID-19 Forecasting TeamPast SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysis.Lancet. 2023; 401: 833-842Summary Full Text Full Text PDF PubMed Scopus (151) Google Scholar A growing body of evidence has shown that vaccination is one of the most effective ways to protect against severe COVID-19 illness, including hospitalisation and death due to SARS-CoV-2 infection. A large national cohort population study of 5 819 264 participants in the USA has shown that individuals with SARS-CoV-2 re-infection have a statistically significantly higher risk of death, hospitalisation, and sequelae in multiple organ systems during the acute and post-acute phases and that re-infection increases the overall burden of disease.2Bowe B Xie Y Al-Aly Z Acute and postacute sequelae associated with SARS-CoV-2 reinfection.Nat Med. 2022; 28: 2398-2405Crossref PubMed Scopus (238) Google Scholar Notably, this study found up to 86·7% of individuals with SARS-CoV-2 re-infection were unvaccinated (as presented in table s6 of the study's appendix).2Bowe B Xie Y Al-Aly Z Acute and postacute sequelae associated with SARS-CoV-2 reinfection.Nat Med. 2022; 28: 2398-2405Crossref PubMed Scopus (238) Google Scholar Another large national cohort population study of 1 516 702 participants in England looked at individuals infected with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants and found that booster vaccination, with mRNA vaccines, was highly protective against hospitalisation and death compared with unvaccinated individuals.3Nyberg T Ferguson NM Nash SG et al.Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1·1.529) and delta (B.1·617·2) variants in England: a cohort study.Lancet. 2022; 399: 1303-1312Summary Full Text Full Text PDF PubMed Scopus (754) Google Scholar The subvariants of omicron such as XBB.1.5 and EG.5 are currently the dominant variants. The Lancet Editorial published on Jan 14, 2023, specifically highlighted that the COVID-19 pandemic is far from over.4The LancetThe COVID-19 pandemic in 2023: far from over.Lancet. 2023; 401: 79Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar Importantly, a new study released by the US Centers for Disease Control and Prevention shows that the bivalent mRNA booster dose vaccine reduces the risk of symptomatic infection from XBB.1.5 by 40–50%.5Link-Gelles R Ciesla AA Roper LE et al.Early estimates of bivalent mRNA booster dose vaccine effectiveness in preventing symptomatic SARS-CoV-2 infection attributable to omicron BA.5 - and XBB/XBB.1·5-related sublineages among immunocompetent adults—increasing community access to testing program, United States, December 2022–January 2023.MMWR Morb Mortal Wkly Rep. 2023; 72: 119-124PubMed Google Scholar More than 5·53 billion people (approximately 70% of the world's population) have received one dose of a COVID-19 vaccine. One reason why the remaining 30% of the population is unvaccinated is poor access to COVID-19 vaccines in low-income countries. Another reason, however, is a substantial proportion of people choosing not to be vaccinated due to little knowledge, differing attitudes and beliefs, or concerns about the safety and efficacy of the vaccines. According to the WHO Strategic Advisory Group of Experts, vaccine hesitancy is defined as "delay in acceptance or refusal of vaccination despite the availability of vaccination services".6MacDonald NE SAGE Working Group on Vaccine HesitancyVaccine hesitancy: definition, scope and determinants.Vaccine. 2015; 33: 4161-4164Crossref PubMed Scopus (3091) Google Scholar The prevalence of vaccine hesitancy worldwide is 25%.7Fajar JK Sallam M Soegiarto G et al.Global prevalence and potential influencing factors of COVID-19 vaccination hesitancy: a meta-analysis.Vaccines. 2022; 101356Crossref Scopus (63) Google Scholar The characteristics of the population at greater risk of vaccine hesitancy were female, younger than 50 years, single, unemployed, living in a household of five or more people, having less than an undergraduate degree in education, working in a non-health-care-related job, and considering the COVID-19 vaccines to be unsafe.7Fajar JK Sallam M Soegiarto G et al.Global prevalence and potential influencing factors of COVID-19 vaccination hesitancy: a meta-analysis.Vaccines. 2022; 101356Crossref Scopus (63) Google Scholar Vaccine hesitancy can be influenced by reports about vaccine risks and perceptions of changing threat levels of COVID-19. The hesitation to vaccinate can range from ready to vaccinate to neutral about vaccines to resistant to vaccination. Mapping of hesitancy to vaccinate by public health policy makers is an important step to address the continued spread of misinformation about COVID-19 vaccines. The ambiguity of reporting in academic journals can lead to further misinterpretation of findings in general media, which can further contribute to hesitancy to vaccinate. Hence, we call for a better understanding of maps of vaccine indecision and the negative perceptions of the COVID-19 vaccines to allow for more transparent and precise reporting of current studies regarding COVID-19 and vaccines and to consequently address issues of global vaccine hesitancy. CY and SJT report a grant from the Canadian Institutes of Health Research (grant number 177747). LL reports no competing interests. Past SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysisProtection from past infection against re-infection from pre-omicron variants was very high and remained high even after 40 weeks. Protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants. The immunity conferred by past infection should be weighed alongside protection from vaccination when assessing future disease burden from COVID-19, providing guidance on when individuals should be vaccinated, and designing policies that mandate vaccination for workers or restrict access, on the basis of immune status, to settings where the risk of transmission is high, such as travel and high-occupancy indoor settings. Full-Text PDF Open Access